Methotrexate medication form – Studholme Medical Centre

You are on Methotrexate. It is now a requirement that we have the ‘DAY’ of the week specified on the directions. This is important for other care settings, such as an admission to hospital so they can continue your care when required without delay.

First name(Required)

Surname(Required)

Date of birth(Required)

Contact number(Required)

Can you please tick the day of the week you take your methotrexate(Required)

We will then add this information to future prescriptions.

Not for urgent medical help(Required)

Yes, I understand this form is NOT for urgent medical help